Accupril: Effective Blood Pressure Control for Cardiovascular Health
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Accupril (quinapril hydrochloride) is an angiotensin-converting enzyme (ACE) inhibitor prescription medication specifically formulated for the management of hypertension and heart failure. As a trusted therapeutic option in cardiovascular medicine, it works by relaxing blood vessels to allow blood to flow more smoothly, thereby reducing the heart’s workload. This medication represents a cornerstone treatment in modern cardiology practice, offering both efficacy and a well-established safety profile when administered under proper medical supervision.
Features
- Active ingredient: Quinapril hydrochloride
- Available in tablet formulations: 5 mg, 10 mg, 20 mg, and 40 mg strengths
- Mechanism: Selective inhibition of angiotensin-converting enzyme (ACE)
- Bioavailability: Approximately 60% following oral administration
- Protein binding: 97% bound to plasma proteins
- Elimination half-life: Approximately 2 hours for quinapril, 3 hours for active metabolite
- Excretion: Primarily renal (61%) and fecal (37%)
- Onset of action: Within 1 hour for blood pressure reduction
- Maximum effect: Achieved within 2-4 hours post-dose
- Duration of action: 24-hour blood pressure control with once-daily dosing
Benefits
- Provides consistent 24-hour blood pressure control with single daily dosing in many patients
- Reduces afterload on the heart, improving cardiac output in heart failure patients
- Demonstrates renal protective effects in hypertensive patients with diabetes
- Shows proven mortality reduction in heart failure when used as part of comprehensive therapy
- Offers flexible dosing options to accommodate individual patient needs and response
- Maintains efficacy throughout the dosing interval without significant peak-trough fluctuations
Common use
Accupril is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with thiazide diuretics. It is also approved for the management of heart failure as adjunctive therapy when added to conventional treatment including diuretics and digitalis. Clinical evidence supports its use in slowing the progression of renal disease in hypertensive patients with diabetes and microalbuminuria. The medication may be used off-label in certain cardiovascular conditions under specialist supervision, though such use requires careful risk-benefit assessment.
Dosage and direction
For hypertension management, the initial recommended dose is 10-20 mg once daily. Dosage should be adjusted based on blood pressure response at peak (2-6 hours post-dose) and trough (prior to next dose) blood pressure measurements. The usual maintenance dosage range is 20-80 mg daily, administered as a single dose or in two divided doses. For heart failure, therapy should be initiated at 5 mg twice daily under close medical supervision. This may be increased weekly based on clinical response and tolerability, with a target maintenance dose of 20-40 mg daily in two divided doses. Dosage adjustment is necessary in patients with renal impairment: for creatinine clearance >60 mL/min, no adjustment needed; 30-60 mL/min, initiate with 5 mg daily; 10-30 mL/min, initiate with 2.5 mg daily. Tablets should be swallowed whole with water and may be taken with or without food, though consistency in administration relative to meals is recommended.
Precautions
Patients should be monitored for hypotension, especially during initial dosing and dosage adjustments. Renal function and serum potassium should be assessed prior to initiation and periodically during therapy. Caution is advised in patients with renal artery stenosis, as acute renal failure may occur. Angioedema may occur at any time during treatment, requiring immediate discontinuation and appropriate medical intervention. Neutropenia/agranulocytosis has been reported with ACE inhibitors; patients with collagen vascular disease or renal impairment may be at increased risk. Use during pregnancy should be avoided, particularly during the second and third trimesters, due to potential fetal harm. Patients should be advised to avoid dehydration and excessive perspiration, which may potentiate blood pressure-lowering effects.
Contraindications
Accupril is contraindicated in patients with known hypersensitivity to quinapril or any other ACE inhibitor. History of angioedema related to previous ACE inhibitor therapy represents an absolute contraindication. The medication must not be used concomitantly with aliskiren in patients with diabetes. Co-administration with neprilysin inhibitors is contraindicated due to increased risk of angioedema. Use is contraindicated during pregnancy due to potential fetal injury and death. The medication should not be administered to patients with hereditary or idiopathic angioedema.
Possible side effect
Common adverse reactions (occurring in >1% of patients) include headache (5.6%), dizziness (4.2%), fatigue (2.1%), cough (1.9%), and nausea (1.5%). Less frequent side effects include orthostatic hypotension (0.8%), vomiting (0.7%), and diarrhea (0.6%). Serious but rare adverse events include angioedema (0.1%), which may involve the face, lips, tongue, glottis, or larynx; hyperkalemia; neutropenia/agranulocytosis; and hepatic failure. Approximately 2% of patients discontinue therapy due to cough, which is typically dry, persistent, and resolves after discontinuation. Laboratory abnormalities may include elevated BUN and serum creatinine (in patients with renal artery stenosis, heart failure, or volume depletion), and increased serum potassium.
Drug interaction
Accupril may potentiate the hypotensive effects of diuretics and other antihypertensive agents. Concomitant use with potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium may lead to significant hyperkalemia. NSAIDs may diminish the antihypertensive effect and increase risk of renal impairment. Lithium toxicity may occur due to reduced renal clearance. Tetracycline absorption may be reduced. Dual blockade of the renin-angiotensin system with ARBs, aliskiren, or other ACE inhibitors increases risks of hypotension, hyperkalemia, and renal impairment. Gold injections may cause nitritoid reactions. Alcohol may potentiate vasodilation and hypotensive effects.
Missed dose
If a dose is missed, it should be taken as soon as remembered on the same day. If it is near the time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed dose. Consistency in dosing is important for maintaining stable blood pressure control. Healthcare providers should educate patients about the importance of adherence to prescribed dosing regimens and establish strategies to minimize missed doses.
Overdose
The most likely manifestation of overdose is hypotension, which may be severe. Other symptoms may include bradycardia, circulatory shock, hyperkalemia, hyponatremia, and renal failure. Management should include supportive measures with emphasis on correction of hypotension through volume expansion with normal saline. Hemodialysis may be effective in removing quinapril and its metabolites. Vital signs, serum electrolytes, and creatinine should be monitored closely. Vasopressors may be required in cases of severe hypotension unresponsive to volume expansion. Patients should be advised to seek immediate medical attention if overdose is suspected.
Storage
Accupril tablets should be stored at controlled room temperature, 20°-25°C (68°-77°F), with excursions permitted to 15°-30°C (59°-86°F). The medication must be kept in its original container with the lid tightly closed to protect from moisture and light. Tablets should not be stored in bathroom cabinets or other areas with high humidity. Keep out of reach of children and pets. Do not use tablets that show signs of discoloration, cracking, or other physical deterioration. Proper disposal of expired or unused medication should follow local regulations, typically through medication take-back programs.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Accupril is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual response to therapy may vary, and treatment decisions should be based on comprehensive medical evaluation. Patients should not initiate, discontinue, or modify dosage without consulting their healthcare provider. The full prescribing information should be consulted for complete details regarding use, warnings, and precautions.
Reviews
Clinical studies demonstrate that Accupril effectively reduces blood pressure in 60-70% of patients with mild to moderate hypertension. In heart failure trials, it has shown significant improvement in exercise tolerance and reduction in hospitalizations. Patient satisfaction surveys indicate good tolerability profile, though cough remains a notable reason for discontinuation in some populations. Long-term follow-up studies support its cardiovascular protective effects, particularly in high-risk patient groups. Real-world evidence confirms the efficacy and safety profile observed in clinical trials when used according to prescribing guidelines.